Tuesday, May 18, 2010

Book-A-Day 2010 # 104 (5/18) -- The Checklist Manifesto by Atul Gawande

Everyone wants easy answers. For every problem, we secretly think, there must be a simple, easily-applied solution that everyone can understand. Look at whatever politicians you like least -- don't they preach easy solutions to problems? Look at The Secret -- or any self-help book, for that matter. (Or most personal-finance books.) Look at the thousand talk shows and their devil spawn, the "fix your life" shows -- that will correct a chosen person's house or life or job or wardrobe or what-have-you in half an hour, with time out for mop advertisements. Look at all of modern culture.

The Checklist Manifesto looks very much like yet another work in that very same vein -- Gawande, a noted surgeon and writer (a regular in the New Yorker, two previous bestsellers on doctor-y topics), has a thesis that many complicated tasks and processes can be improved by following checklists. But it's not quite as simple and easy as the marketing copy for Checklist Manifesto would have you think it is -- Gawande is clear that a good checklist, one that actually does capture the most important steps and will improve processes, requires a lot of thought and work and trial-and-error before it actually will improve processes.

Gawande discovered checklists through commercial aviation, the field that has used them the most extensively and for the longest time (since test pilots created the first one while flying the B-17 bomber in the 1930s), and has refined the use of checklists the most. And he came to see the need for checklist through his surgical practice, where a thousand tiny details have to be tracked carefully -- and usually during times of high stress -- to ensure a successful outcome for the patient.

Gawande is a strong reporter of the New Yorker school; he examines various kinds of checklists in different areas (most notably the construction of skyscrapers, along with medicine and aviation) and explains his own successes and setbacks in implementing surgical checklists, both in his own practice and as part of a World Health Organization imitative. (Gawande is low-key about all of his work, but one begins to wonder when this star writer, star surgeon, star professor, and globe-trotting UN functionary finds time to sleep, let alone to nod at his wife and three children once every so often.)

A checklist is not a panacea, of course, though Gawande does insist that it is an immensely useful tool for a wide swath of complicated human activities. And he makes a good case that, in so many of these areas, the work that needs to be done quickly is now too complex to be easily remembered and followed. He probably overstates his case slightly -- a popular book on a subject like this could hardly not -- but the model of aviation is very compelling, and it's clear that many other fields, not least medicine, could stand to improve their procedures through some carefully designed and implemented checklists.
Book-A-Day 2010: The Epic Index
Listening to: Mieka Pauley - Marked Man
via FoxyTunes

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